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Study Indicates Strong Consumer Preference to Fix Medicare Part D and Medicaid Flaws Threatening Access to Prescription Drugs

ALEXANDRIA, Va., Dec. 18 /PRNewswire-USNewswire/ -- Patients believe that access to their prescription medications for government health care programs should not be compromised by unfair reimbursement practices and policies to their community pharmacy providers, according to a new survey from the polling company(TM), inc.

"Our patients have it right: they know community pharmacies play a critical role in their health care," said Stephen Giroux, PD, NCPA president and owner of five pharmacies in Western New York. "They want us there to address their health care needs. Now Congress needs to heed their request and pass specific Medicare and Medicaid reimbursement fixes before more local pharmacies are forced out of these government programs, or have to close their doors."

The Coalition for Community Pharmacy Action--comprised of the National Community Pharmacists Association (NCPA) and National Association of Chain Drug Stores (NACDS)--commissioned the polling company(TM), inc., to conduct a comprehensive survey of 1,000 pharmacy patients nationwide from November 26 - December 2, with a margin of error of (+/-) 3. From a legislative perspective, the level of patient support for fixing the current slow reimbursement of Medicare Part D prescription drugs by the pharmacy benefit managers (PBMs) that administer the plans, and the forthcoming cuts in the reimbursement of Medicaid generic prescription drugs was resounding.

The survey found 83 percent of respondents said it was unfair that "PBMs and prescription drug plans keep money as long as possible, allowing them to earn interest on it, while pharmacies must continue to provide their services and prescription drugs upfront to patients even though they haven't been paid." The survey also found 83 percent support "new legislation in Congress to ensure pharmacies providing Medicare Part D patients are reimbursed by the government within 14 days."

Slow pharmacy reimbursement of Medicare Part D prescription drug claims by PBMs cause cash flow problems for community pharmacies that force them to take out loans in the tens to hundreds of thousands of dollars range. The bills - H.R.1474, the Fair and Speedy Treatment of Medicare Prescription Drug Act of 2007, and S.1954, the Pharmacy Access Improvement Act (PhAIM) of 2007?require complete and accurate Part D claims submitted electronically be paid within 14 days by electronic funds transfer, and paper claims within 30 days.

In addition, the survey found 78 percent thought it was unfair that "under the new rule, pharmacies that participate in the Medicaid program would have to sell generic drugs at a loss." The survey also found 78 were less likely to support the new rule because "many community pharmacies will not be able to continue servicing Medicaid patients, including children," especially after they learn "over 28 million children in the U.S. get prescription medications paid for by the Medicaid and account for over half of the beneficiaries." Furthermore, the survey found 74 percent support legislation that would reimburse pharmacy more fairly.

The Centers for Medicare & Medicaid Services' (CMS) Medicaid generic prescription drug pharmacy reimbursement formula is based on a flawed Average Manufacturer Price (AMP). According to a Government Accountability Office study, on average community pharmacies will be reimbursed at least 36 percent below their acquisition costs when the change is fully implemented in early 2008. While the legislative solutions are slightly different in the House and Senate, the goal of limiting the damage AMP would have on community pharmacies is the same. H.R.3140, the Saving Our Community Pharmacies Act, establishes a new and fair pharmacy reimbursement benchmark reflective of what the actual retail costs are and includes provisions to drive generic drug utilization that increase taxpayer savings. While S.1951, the Fair Medicaid Drug Payment Act of 2007, is focused on improving the AMP formula criteria for determining the averages and raises the maximum amount of potential reimbursement.

"We have reached critical mass in our efforts to rectify the debilitating consequences of the Medicare Part D and Medicaid reimbursement systems," said Bruce Roberts, RPh, NCPA executive vice president and CEO. "The sentiments expressed by community pharmacies, members of Congress, and organizations such as NCPA and the National Rural Health Association are well known. The missing voice has been the patients who are adversely affected by the consequence of community pharmacies being squeezed to the breaking point. Now we have a comprehensive scientific survey indicating patients find the reimbursement policies objectionable and are supportive of the pending legislative solutions that should spur action in the halls of Congress."

The National Community Pharmacists Association, founded in 1898, represents the nation's community pharmacists, including the owners of more than 23,000 pharmacies. The nation's independent pharmacies, independent pharmacy franchises, and independent chains dispense nearly half of the nation's retail prescription medicines. To learn more go to

SOURCE National Community Pharmacists Association
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